Rheumatoid arthritis is reported to have a 5 year mortality rate of 18% in patients studied in Denmark. The use of biologic agents has led to an encouraging downturn in the mortality in this disease. However, this improvement in survival is seen primarily in patients without additional problems. Interstitial lung disease (scarring of the lung tissue) is one associated problem, which continues to lead to a poorer prognosis. In the Denmark study, patients with rheumatoid arthritis associated interstitial lung disease (RA-ILD) had a 5 year mortality rate of 36%.
There are currently 2 medications on the market which have shown promise in controlling the progression of interstitial lung disease, but there is no real consensus as to what the treatment protocols should be for patients with RA-ILD. Given the overall higher mortality rates in patients with RA-ILD, studies need to be conducted to determine if the current drugs, which slow the progression of fibrotic disease in other conditions, will be partially or wholly successful in controlling lung tissue scarring in the rheumatoid patient and, in turn, further reduce the mortality rate in this group.
Genetics, sex, and ethnicity may play a role in the mortality seen in patients with rheumatoid disease. Smoking, older age, and male sex are also risk factors for RA-ILD. Recently, a drug used to treat pulmonary arterial hypertension (elevated pressure in the blood vessels of the lungs) has shown some promise in scarring disease of the lung. More studies are needed.
